Seldom if ever, is vehicle extrication carried out by a single agency. In every single one of the over 100 countries where I have delivered training, the role of the other agencies is discussed and considered and is always done so in their absence; they are never there.
In my career I never took part in a multi-agency training session in relation to vehicle extrication (with a notable exception I will cover later) and consider this to be not only staggering, but morally unacceptable.
A critically injured patient requires the attention of a highly skilled team of individuals from a number of agencies, principally fire and rescue and paramedics. In recent years (in many countries) we also have to consider the involvement of specialist medical intervention such as a trauma doctor.
How is it possible for that team to come together, work safely, effectively and in a patient centred way, if they do not have a framework in place to ensure they regularly take part in multi-agency training? Are we relying on good luck rather than sound technical and clinical preplanning? Is 2am on a cold, wet and windy night with a critically injured patient in front of us, the place to learn about each other’s skills, requirements, expectations and more importantly, limitations? Of course, these are all rhetorical questions and we all know the answers. We understand too, the difficulties of making this happen.
In many territories around the world, the operational commitments from the multiple agencies involved in vehicles extrication does not lend itself to making quality training time available. A figure I can quote from 2016 from an area of the United Kingdom is that the fire and rescue service were operationally committed (i.e. on their way to or in attendance at an incident) around 10% of the time. The figures for the ambulance service in the same area were in excess of 90%. I understand the issue here, but that is no excuse for the dire lack of agencies working together to ensure a more effective response.
Whilst there are certainly strategic approaches for multi-agency working that have been developed in the last decade, this (in my experience) is not filtering down to practitioners on the road and whilst many organisations now seem far more adept at running major incidents at silver or gold command level, we are seriously overlooking the interagency working at ‘the sharp end’.
There is however some good news, and many local arrangements have been made where crews will train with their local counterparts from other agencies. This tends to be because ‘someone knows someone else’ and very often relies on goodwill; something that is not sustainable. These relationships have often been established by practitioners/instructors across agencies who are passionate about improving working relationships at the roadside. I am aware of some fantastic work being carried out in some countries which involves a wide range of key (and peripheral) agencies. These excellent initiatives are sadly the exception rather than the rule and the many conversations and straw poles I have conducted over the last decade or so certainly lead me to conclude that we simply do not do this enough.
I myself developed such a partnership whilst I was an instructor in the fire service. However, due to financial and political restraints, this soon ceased as ‘the value could not be quantified’. I can vouch for the value. It created a bond (and friendships) between firefighters and paramedics who continue to communicate and learn from each other ten years later. It brought the two ‘alien’ worlds together in a controlled, relaxed environments and allowed the protagonists to understand the on-scene decisions made by their counterparts. It answered many unanswered questions that had lingered for years and made future working more safe, efficient and patient centred.
Does it save lives? Well that is a piece of academic work that needs doing as there is very little, if any, research attributed to vehicle extrication. The harsh truth is, vehicle extrication is never studied or critiqued in a way that provides us with useful data and we have no clear idea of how ‘successful’ we really are. We would all like to think that we are at the top of our game, but I would ask the question; how can we be? Multi agency training (and training in the general sense) must be the focus of our desire to be better at what we do across all disciplines of technical and medical rescue. Without it, we really are leaving a great deal to chance.
Conclusion
Every patient deserves the very best response, so I would urge all rescue professionals to seek a way of enhancing you own (and your teams) capability by working closely with your partners. This must mean establishing a robust multi agency training plan that is constantly reviewed and updated and covers all levels of your respective organisations. There are examples of good practice in relation to multi agency training, but this is far from the norm and the vast majority of practitioners simply do not work closely enough with their peers in a training environment.
Establishing a sustainable training plan is only the beginning and we must provide a mechanism to test the efficacy of our multi agency approach. Knowing how well we are performing and understanding any areas for improvement is vital for us to progress. Whilst difficult, it is the only possible way to ensure your patient gets the very best response which is after all, why you are there.
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